Heat-Resistant Aphanizomenon flos-aquae (AFA) Extract (Klamin®) as a Functional Ingredient in Food Strategy for Prevention of Oxidative Stress

Microalgae are generally considered an excellent source of vitamins, minerals, and bioactive molecules that make them suitable to be introduced in cosmetics, pharmaceuticals, and food industries. Aphanizomenon flos-aquae (AFA), an edible microalga, contains numerous biomolecules potentially able to prevent some pathologies including age-related disorders. With the aim to include an AFA extract (Klamin®) as a functional ingredient in baked products, we investigated if its bioactive molecules are destroyed or inactivated after standard cooking temperature. The AFA extract was exposed to heat stress (AFA-HS), and no significant decrease in pigment, polyphenol, and carotenoid content was detected by spectroscopic analysis. Thermal stability of AFA-HS extract was demonstrated by thermogravimetric analysis (TGA), and no change in the morphology of the granules of the powder was noticed by SEM microscopic observation. By Folin-Ciocalteu, ORAC, and ABTS assays, no change in the antioxidant activity and polyphenol contents was found after high-temperature exposition. When added in cell culture, solubilized AFA-HS lost neither its scavenging ability against ROS generation nor its protective role against Abeta, the main peptide involved in Alzheimer's disease. Prebiotic and antioxidant activities of AFA extract that are not lost after thermal stress were verified on E. coli bacteria. Finally, AFA-HS cookies, containing the extract as one of their ingredients, showed increased polyphenols. Here, we evaluate the possibility to use the AFA extract to produce functional food and prevent metabolic and age-related diseases.

Squamous Cell Carcinoma Antigen (SCC), Carcinoembryonic Antigen (CEA), and Tumour-Associated Trypsin Inhibitor (TATI) for Monitoring Head and Neck Cancer

Eighty-eight patients with head and neck cancer were prospectively monitored, before and after treatment, by means of simultaneous serum SCC, CEA and TATI measurements. Thirty-two (36.6%) patients had early stages (I, II, III) and 56 (63.4%) advanced (stage IV) or recurrent disease. Pre-treatment serum SCC levels were elevated in 20.4% of patients, CEA in 27.2% and TATI in 4.5%. There was no correlation between the incidence of TATI elevation and tumour burden; this marker did not increase with progressing disease stages. CEA and SCC had low sensitivity in the early stages of head and neck cancer and reached 35.7% (20/56 patients) and 25% (14/56 patients) in stage IV or recurrent disease. Despite the low sensitivity of these tumour markers, there was a correlation between tumour marker levels and the course of the disease. This study indicates that the routine assessment of SCC, CEA and TATI serum levels is of no value. However, it can be used as a potential tool for monitoring the efficacy of individual therapy in both early and advanced stages of head and neck cancer.

Influence of topography of nanofibrous scaffolds on functionality of engineered neural tissue

Properly engineered scaffolds combined with functional neurons can be instrumental for the effective repair of the neural tissue. In particular, it is essential to investigate how three-dimensional (3D) systems and topographical features can impact on neuronal activity to obtain engineered functional neural tissues. In this study, polyphenylene sulfone (PPSu) scaffolds constituted by randomly distributed or aligned electrospun nanofibers were fabricated to evaluate the neural activity in 3D culture environments for the first time. The obtained results demonstrated that the nanofibers can successfully support the adhesion and growth of neural stem cells (NSCs) and enhance neuronal differentiation compared to 2D substrates. In addition, NSCs could spread and migrate along the aligned fibers. The percentage of active NSC-derived neurons and the overall network activity in the fibrous substrates were also remarkably enhanced. Finally, the data of neuronal activity showed not only that the neurons cultured on the nanofibers are part of a functional network, but also that their activity increases, and the direction of neural signals can be controlled in the aligned 3D scaffolds.

Enhanced oil removal from water in oil stable emulsions using electrospun nanocomposite fiber mats

Fibrous mats with hydrophobic and oleophilic properties have been fabricated and used as absorbents of oil from stable water in oil emulsions.

Ultra-efficient, widely tunable gold nanoparticle-based fiducial markers for X-ray imaging

We show the development of a new class of highly efficient, biocompatible fiducial markers for X-ray imaging and radiosurgery, based on polymer shells encapsulating engineered gold nanoparticle (AuNP) suspensions. Our smart fabrication strategy enables wide tunability of the fiducial size, shape, and X-ray attenuation performance, up to record values >20 000 Hounsfield units (HU), i.e. comparable to or even higher than bulk gold. We show that the NP fiducials allow for superior imaging both in vitro and in vivo (yet requiring 2 orders of magnitude less material), with strong stability over time and the absence of classical "streak artifacts" of standard bulk fiducials. NP fiducials were probed in vivo, showing exceptional contrast efficiency, even after 2 weeks post-implant in mice.

Correction: Ultra-efficient, widely tunable gold nanoparticles-based fiducial markers for X-ray imaging

Correction for 'Ultra-efficient, widely tunable gold nanoparticles-based fiducial markers for X-ray imaging' by Gabriele Maiorano, et al., Nanoscale, 2016, DOI: 10.1039/c6nr07021c.

Fumarate-loaded electrospun nanofibers with anti-inflammatory activity for fast recovery of mild skin burns

In the biomedical sector the availability of engineered scaffolds and dressings that control and reduce inflammatory states is highly desired, particularly for the management of burn wounds. In this work, we demonstrate for the first time, to the best of our knowledge, that electrospun fibrous dressings of poly(octyl cyanoacrylate) (POCA) combined with polypropylene fumarate (PPF) possess anti-inflammatory activity and promote the fast and effective healing of mild skin burns in an animal model. The fibers produced had an average diameter of (0.8  ±  0.1) µm and they were able to provide a conformal coverage of the injured tissue. The application of the fibrous mats on the burned tissue effectively reduced around 80% of the levels of pro-inflammatory cytokines in the first 48 h in comparison with un-treated animals, and enhanced skin epithelialization. From histological analysis, the skin thickness of the animals treated with POCA : PPF dressings appeared similar to that of one of the naïve animals: (13.7  ±  1.4) µm and (14.3  ±  2.5) µm for naïve and treated animals, respectively. The density of dermal cells was comparable as well: (1100  ±  112) cells mm(-2) and (1358  ±  255) cells mm(-2) for naïve and treated mice, respectively. The results demonstrate the suitability of the electrospun dressings in accelerating and effectively promoting the burn healing process.

Oil removal from water–oil emulsions using magnetic nanocomposite fibrous mats

PMMA-based magnetic nanocomposite fibrous mats reach oil absorption efficiencies up to 90% in water–oil stable emulsions.

Fibrous wound dressings encapsulating essential oils as natural antimicrobial agents

Essential oils with high antibiotic activity were incorporated into cellulose acetate natural polymer. By using the electrospinning technique, nanofibrous matrices were prepared to be used as effective antimicrobial wound dressings.

Laser-induced disaggregation of TiO₂ nanofillers for uniform nanocomposites

Exploiting the intrinsic photosensitivity of TiO₂ nanoparticles, we demonstrated how ultraviolet (UV) pulsed laser irradiation of acrylate polymer nanocomposite solutions can separate the initial clusters of these colloidal semiconductor nanorods into clearly distinct units. From the irradiated solutions, optically clear nanocomposite films are obtained which exhibit enhanced optical properties with respect to the nanocomposites obtained without previous UV treatment.

Polymeric foams with functional nanocomposite cells

Elastomeric foams with controlled cell size and composition are formed by using calcium alginate hydrogel beads as templates.

Towards excimer-laser-based stereolithography: a rapid process to fabricate rigid biodegradable photopolymer scaffolds

We demonstrate high-resolution photocross-linking of biodegradable poly(propylene fumarate) (PPF) and diethyl fumarate (DEF) using UV excimer laser photocuring at 308 nm. The curing depth can be tuned in a micrometre range by adjusting the total energy dose (total fluence). Young's moduli of the scaffolds are found to be a few gigapascal, high enough to support bone formation. The results presented here demonstrate that the proposed technique is an excellent tool for the fabrication of stiff and biocompatible structures on a micrometre scale with defined patterns of high resolution in all three spatial dimensions. Using UV laser photocuring at 308 nm will significantly improve the speed of rapid prototyping of biocompatible and biodegradable polymer scaffolds and enables its production in a few seconds, providing high lateral and horizontal resolution. This short timescale is indeed a tremendous asset that will enable a more efficient translation of technology to clinical applications. Preliminary cell tests proved that PPF : DEF scaffolds produced by excimer laser photocuring are biocompatible and, therefore, are promising candidates to be applied in tissue engineering and regenerative medicine.

Wettability control by laser texturing process generating localized gold nanoparticles on polymeric thin films

In this work a new approach is introduced for surface properties control by laser texturing process. By UV laser irradiation, we are able to control the surface wettability of a chitosan polymeric film in which is introduced a chloroauric acid salt by immersion. Specifically the UV irradiation is responsible for the creation of gold nanoparticles at the irradiated surface of the polymeric film. This photolytic process allows us to localize and design accurately surface patterns and moreover to tune metallic particle size in the range of nanoscale. After the characterization of our gold textured surfaces by atomic force and scanning electron microscopies, we demonstrate the link between wettability surface properties and gold nanoparticles size. The experimental results indicate the influence of the laser intensity, the irradiation time and the polymer film thickness (by increasing the gold concentration) on the gold nanoparticle density and size.

Improvements of optical tactile sensors for robotic system by gold nanocomposite material

In this work we propose the evolution of a new class of optical pressure sensors suitable for robot tactile sensing. The sensors are based on a tapered optical fiber, where optical signals travel embedded into a PDMS-gold nanocomposite material. By applying different pressure forces on the PDMS-based nanocomposite we measure in real time the change of the optical transmitted intensity due to the coupling between the gold nanocomposite material and the tapered fiber region. The intensity reduction of the transmitted light intensity is correlated with the pressure force magnitude.

Microscale patterning of hydrophobic/hydrophilic surfaces by spatially controlled galvanic displacement reactions

In this letter, we report the design and fabrication of different metal patterns for the realization of spatially controlled hydrophobic/hydrophilic regions with micrometer resolution. The fabrication procedure, based on a combination of lithographic techniques and wet-chemistry reactions (namely, spontaneous Galvanic displacement reactions) is reliable, undemanding, and highly versatile, allowing the achievement of precise spatial control along with the use of a wide variety of different materials.

Patterned structures of in situ size controlled CdS nanocrystals in a polymer matrix under UV irradiation

A method of in situ formation of patterns of size controlled CdS nanocrystals in a polymer matrix by pulsed UV irradiation is presented. The films consist of Cd thiolate precursors with different carbon chain lengths embedded in TOPAS polymer matrices. Under UV irradiation the precursors are photolyzed, driving to the formation of CdS nanocrystals in the quantum size regime, with size and concentration defined by the number of incident UV pulses, while the host polymer remains macroscopically/microscopically unaffected. The emission of the formed nanocomposite materials strongly depends on the dimensions of the CdS nanocrystals, thus, their growth at the different phases of the irradiation is monitored using spatially resolved photoluminescence by means of a confocal microscope. X-ray diffraction measurements verified the existence of the CdS nanocrystals, and defined their crystal structure for all the studied cases. The results are reinforced by transmission electron microscopy. It is proved that the selection of the precursor determines the efficiency of the procedure, and the quality of the formed nanocrystals. Moreover it is demonstrated that there is the possibility of laser induced formation of well-defined patterns of CdS nanocrystals, opening up new perspectives in the development of nanodevices.

Synergistic interaction between a mixed ligand copper (II) chelate complex and two anticancer agents in T47D human breast cancer cells in vitro

PURPOSE

We have developed a copper(II) chelate complex with a tridentate ONN-Schiff ligand and the anion of salicylate, showing a potent cytotoxic activity against a panel of human and murine cancer cell lines. In this experiment we have explored the combination effect between Cu(SalNEt(2))salicylate (Cu-Sal) complex and two widely used drugs in cancer chemotherapy, bleomycin (BLM) and 5-fluorouracil (5-FU), against T47D human breast cancer cells. Previous theoretical quantum-chemical studies of this complex and ass adducts with biological molecules elucidated the underlying mechanism of action of this complex.

MATERIALS AND METHODS

Cells grown in adherence in 96-well microplates were exposed simultaneously to both agents for 48 h. During cytotoxicity was assessed via the XTT colorimetric assay. The combined drug interaction was assessed with the median-effect analysis and the combination index (CI).

RESULTS

Concurrent treatment of cells with Cu-Sal complex and the chemotherapeutic drugs BLM and 5-FU and the antioxidant agent ascorbic acid (AsA) resulted mainly in synergistic interaction for most concentration ratios.

CONCLUSION

Cu-Sal complex interacts synergistically with the chemotherapeutic drugs for most schedules of administration. These findings call for prompting to search for possible interaction of this complex with other cellular elements of fundamental importance in cell proliferation.

Making silicon hydrophobic: wettability control by two-lengthscale simultaneous patterning with femtosecond laser irradiation

We report on the wettability properties of silicon surfaces, simultaneously structured on the micrometre-scale and the nanometre-scale by femtosecond (fs) laser irradiation to render silicon hydrophobic. By varying the laser fluence, it was possible to control the wetting properties of a silicon surface through a systematic and reproducible variation of the surface roughness. In particular, the silicon-water contact angle could be increased from 66° to more than 130°. Such behaviour is described by incomplete liquid penetration within the silicon features, still leaving partially trapped air inside. We also show how controllable design and tailoring of the surface microstructures by wettability gradients can drive the motion of the drop's centre of mass towards a desired direction (even upwards).

Weekly chemotherapy with carboplatin, docetaxel and irinotecan in advanced non-small-cell-lung cancer: a phase II study

The aim of this study was to evaluate the efficacy and tolerability of carboplatin, docetaxel plus irinotecan given weekly to patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). 50 patients with previously untreated NSCLC (stage IIIB 10; stage IV 40; 44% squamous cell carcinoma; median Eastern Cooperative Oncology Group (ECOG) status 1) received intravenous (i.v.) carboplatin area under the curve (AUC) 2, docetaxel 20 mg/m(2) and irinotecan 60 mg/m(2) on days 1, 8 and 15, repeated every 5 weeks. Prophylactic granulocyte colony-stimulating factor (G-CSF) 150 ug/m(2) was given from days 3 to 6 and 10 to 13. Response was evaluated every two cycles. Four complete responses (8%) and 24 (48%) partial responses were observed, giving an overall intent-to-treat response rate of 56%. 8 patients (16%) achieved stable disease and 14 (28%) progressed. The median time to progression (TTP) was 9.6 months (range 2.5-21.8 months), median survival was 14.8 months (range 0.3-27+ months) and actuarial 1-year survival time was 55%. Grade 3/4 anaemia and thrombocytopenia occurred in 18 and 22% of patients, respectively; 13 patients (26%) developed grade 3/4 neutropenia and 7 (14%) had neutropenic fever that required hospitalisation, but was successfully treated with antibiotics and G-CSF support. One patient developed a severe allergy during docetaxel administration and was withdrawn. Other grade 3/4 adverse events included diarrhoea (n=14; 3 required hospitalisation), nausea/vomiting (n=9), neurotoxicity (n=5) and fatigue (n=5). 6 patients required a dose reduction. This combination of i.v. carboplatin AUC 2, docetaxel 20 mg/m(2) and irinotecan 60 mg/m(2) given weekly is highly effective in the treatment of chemotherapy-naïve advanced NSCLC. Toxicity was moderate, but manageable.

Weekly chemotherapy with docetaxel, gemcitabine and cisplatin in advanced transitional cell urothelial cancer: a phase II trial

PURPOSE

To evaluate the efficacy and toxicity of a combination of weekly docetaxel, gemcitabine and cisplatin in advanced transitional cell carcinoma (TCC) of the bladder.

PATIENTS AND METHODS

Thirty-five chemotherapy-naïve (adjuvant and neoadjuvant chemotherapy was allowed) patients with advanced TCC received intravenous docetaxel 35 mg/m2, gemcitabine 800 mg/m2 and cisplatin 35 mg/m2, on days 1 and 8 every 3 weeks. Prophylactic granulocyte-colony stimulating factor was given from days 3 to 6 and days 10 to 15, anti-emetics were used routinely.

RESULTS

Most (27) patients (77.1%) had a performance status of 0 to 1 and eight (22.9%) had received prior adjuvant or neoadjuvant cisplatin-based chemotherapy. In the intention-to-treat analysis, the objective response rate was 65.6% [23/35 patients, 95% confidence interval (CI) 47.8% to 80.9%]. Ten patients (28.5%) achieved a complete response (95% CI 14.6% to 46.3%) and 13 (37.1%) a partial response (95% CI 21.5% to 55.0%). Median survival time was 15.5 months, median duration of response was 10.2 months and median time to progression was 8.9 months. Ten patients (28.5%) developed grade 3/4 neutropenia, including five (14.3%) who experienced febrile neutropenia, which was successfully treated. Grade 3/4 anaemia and thrombocytopenia occurred in 20% and 25.7% of patients, respectively; four patients required platelet transfusions. There were no treatment-related deaths.

CONCLUSIONS

Weekly docetaxel, gemcitabine plus cisplatin is a highly effective treatment for chemotherapy-naïve advanced TCC, and causes only moderate toxicity. This regimen should be considered as a suitable option that deserves further prospective evaluation through randomised phase III trials.

Maternal and neonatal outcome of 100 consecutive triplet pregnancies

The objective of this study is to determine the maternal and neonatal outcome of a large group of triplet gestations. A retrospective review of 100 triplet gestations managed and delivered between January 1992 and September 1999 by a single perinatal group is examined. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilized. Ninety-six percent of the pregnancies had at least one complication, with preterm labor the most common. The median gestational age at delivery was 33 weeks (range 20.4 to 37, SD 4.1 weeks) with 14% of pregnancies delivering prior to 28 weeks' gestation. The corrected perinatal mortality rate was 97/1000. Minimal long-term morbidity was seen with delivery after 27 weeks' gestation. Pregnancy outcome did not vary with birth order or mode of conception. Triplet pregnancy is associated with a high rate ofantenatal complications. Favorable neonatal outcome can be obtained without the use of prophylactic interventions.

Chemotherapy with cisplatin, epirubicin and docetaxel in transitional cell urothelial cancer. Phase II trial

Cisplatin (CDDP), epirubicin (EPI) and docetaxel have single agent activity against urothelial transitional cell carcinoma (TCC). We evaluated the efficacy and toxicity of this combination in locally advanced or metastatic urothelial TCC. Patients with urothelial TCC who had no prior chemotherapy (prior adjuvant chemotherapy > 6 months allowed) were eligible for entry the study. Eligibility criteria were performance status 0-3, granulocyte count (AGC) > or = 1.5 (10(9)/l), platelet count > or = 100 (10(9)/l), clearance creatine > or = 60 ml/min and total bilirubin level < or = 1.5 mg/dl. Treatment consisted of EPI 40 mg/m2 intravenous push, docetaxel 75 mg/m2 in 1 h infusion with premedication and CDDP 75 mg/m2 with pre- and posthydration. Treatment was repeated every 21 days. Antiemetics with dexamethasone and 5-HT3 antagonists were used routinely. Prophylactic haematopoietic growth factors were not used. Patients were evaluated for toxicity weekly and assessed for response every two cycles of treatment. 32 patients were entered into the study and 30 patients (7 with locally advanced and 23 with metastatic disease) were assessable for response. There were 9 (30.0%) complete responses (2, 28.6% in locally advanced and 7, 30.4% in metastatic disease) and 11 (36.7%) partial responses (3, 42.9% in locally advanced and 8, 34.8% in metastatic disease) with an overall response rate (RR) of 66.7% (71.5% in locally advanced, 65.2% in metastatic disease). Overall median survival was 14.5 months (15 months for locally advanced, 12.5 months for metastatic disease). The median duration of response in patients with metastatic disease was 8.5 months. 16 (53.3%) patients required one dose reduction and 5 (16.7%) patients required two dose reductions for a nadir AGC < or = 500/mm3. Four episodes of febrile neutropenia and sepsis occurred. No patient had a dose reduction or treatment delay for any other grade 3/4 toxicity. There were no treatment delays due to myelotoxicity. Alopecia was universal. Non-haematological toxicity including mucositis, fluid retention, allergy, cutaneous toxicity, diarrhoea and neurotoxicity were mild and infrequent. The combination of EPI, docetaxel and CDDP is an active regimen for urothelial TCC. The response rate and toxicity were comparable with the M-VAC (methotrexate, vinblastine, doxorubicin, cisplastin) regimen. Phase III trials comparing this regimen with M-VAC are warranted.

Combination chemotherapy with carboplatin, docetaxel, and gemcitabine in advanced non-small-cell lung cancer: a phase II study

PURPOSE

To evaluate the efficacy and toxicity of the combination of carboplatin, docetaxel, and gemcitabine in patients with advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Forty-five chemotherapy-naive patients with NSCLC were treated on an out-patient basis with carboplatin area under the curve 5 intravenous (IV) and gemcitabine 800 mg/m(2) IV on day 1 and docetaxel 75 mg/m(2) IV and gemcitabine 800 mg/m(2) IV on day 8. Granulocyte colony-stimulating factor (150 ug/m(2) subcutaneously) was given prophylactically from day 3 to day 6 and day 10 to day 16. Chemotherapy was repeated every 4 weeks. Patients were evaluated for response every two cycles of treatment.

RESULTS

The median age of the patients was 58 years (range, 24 to 75 years). The performance status was 0 for 16 patients, 1 for 17 patients, and 2 for 12 patients. Nine patients (20%) had stage IIIB disease, and 36 (80%) had stage IV; histology was mainly squamous cell carcinoma (51.2% of patients) that was poorly differentiated (37.8%). All 45 patients were assessable for toxicity, and 41 were assessable for response. On an intent-to-treat analysis, the objective response rate was 46. 5% (21 out of 45 patients; 95% confidence interval [CI], 31.7% to 62. 5%). Of the 45 patients, four (8.8%) achieved a complete response (95% CI, 2.5% to 21.2%); 17 (37.7%) achieved a partial response (95% CI, 23.8% to 53.5%); seven (15.5%) had stable disease; and 14 (31. 1%) had progressive disease. The median survival time was 13.5 months, and the actuarial 1-year survival rate was 51.11%. The median duration of response was 7.6 months, and the time to tumor progression was 8.1 months. Grade 3/4 anemia and thrombocytopenia occurred in 17.7% and 28.8% of patients, respectively. Twenty-one patients (46.6%) developed grade 3/4 neutropenia, and six patients (13.3%) were complicated with fever. Alopecia was universal. Grade 3 diarrhea occurred in four patients (8.8%); grade 3/4 neurotoxicity occurred in 10 patients (22.2%); and grade 2/3 allergic reaction occurred in three patients (16.6%). There were no treatment-related deaths. Six patients (13.3%) required a dose reduction, two of which required two reductions.

CONCLUSIONS

The combination of carboplatin, docetaxel, and gemcitabine is an effective regimen for the treatment of chemotherapy-naive patients with advanced NSCLC, causing only moderate toxicity.

Impact of gestational age at delivery of the economics of triplet pregnancy

OBJECTIVE

To establish the charges associated with triplet pregnancies managed at a single tertiary center, over a 5-year time period, and to evaluate the impact of prematurity on these charges.

METHODS

All triplet pregnancies that reached at least 20 weeks gestation and received prenatal and neonatal care at our center from 1992 to 1996 were included. Charges for these mothers and neonates were extracted from two separate hospital billing computer systems, encompassing all inpatient, outpatient, technical, and professional charges. Linear regression was used to evaluate the relationship between gestational age at delivery and total charges.

RESULTS

Fifty-five triplet pregnancies were included, resulting in the admission of 149 liveborn neonates. The median gestational age at delivery was 32.1 weeks. The mean charges per triplet mother were: $6,899 (professional), $3,959 (hospital outpatient), and $32,686 (hospital inpatient). The mean charges per neonatal sibling set were: $20,107 (professional) and $124,163 (hospital inpatient). The mean charges per complete triplet pregnancy was $187,814 (maternal plus neonatal). There was a significant inverse relationship between gestational age at delivery and total charges per triplet family, with a decrease of $16,584 for each additional gestational week reached (P = 0.006).

CONCLUSIONS

Triplet pregnancy charges averaged almost $190,000 each, which does not include charges associated with assisted reproductive technologies. These charges are almost all related to the expense of prolonged neonatal intensive care, and are significantly related to the gestational age at delivery. Efforts at containing these costs should focus on reducing the incidence of multiple gestation and preventing prematurity.

Technical dependability of obstetric ultrasound transmission via ISDN

OBJECTIVE

To evaluate the dependability of a live telemedicine link for the transmission of obstetric ultrasonograms using a commercial telephone network.

MATERIALS AND METHODS

We established an integrated services digital network (ISDN), consisting of three dedicated telephone lines from three satellite offices, to our central prenatal diagnostic center. All patients had a sonographic evaluation recorded on videotape by a trained sonographer. A live interactive video telemedicine link was then established, and a perinatologist directed the sonographer through the scan. A report was issued on the basis of the telemedicine examination. The number of calls required to obtain satisfactory real-time images was recorded, as were the reasons for suboptimal transmissions. The first 150 transmissions were excluded from this study. The results in the subsequent 100 patients who agreed to participate were analyzed.

RESULTS

We were able to provide obstetric interpretations in all 100 patients scheduled to be examined using the telemedicine link. A single connection was required in 85 cases, two calls in 5 cases, three calls in 8 cases, four calls in 1 case, and five calls in another case. A repeat call was required in 20 cases because of poor image transmission; other repeat calls were caused by failure to connect (5 cases), calls disconnected (2 cases), and no image transmission (2 cases).

CONCLUSIONS

The provision of telemedicine services for obstetric ultrasonography in the community is feasible, but the need for repeat connections because of technical failures needs to be incorporated into cost and time analyses in order to provide a measure of the system's efficiency.

Effect of ISDN bandwidth on image quality for telemedicine transmission of obstetric ultrasonography

OBJECTIVE

To evaluate objectively the effect of different bandwidths on the ability to interpret obstetric ultrasound scans transmitted live over a commercial telephone network.

MATERIALS AND METHODS

An integrated services digital network (ISDN) was established from three satellite offices to our central prenatal diagnostic center. In the first half of the study, the network was based on four ISDN channels transmitting at a bandwidth of 256 kbits per second (kbps), while in the second half of the study, this was increased to six ISDN channels transmitting at 384 kbps. A physician trained in obstetric ultrasonography provided an interpretation of fetal anatomy using a live, real-time telemedicine link. A scoring system consisting of 33 anatomic items was used to evaluate image quality objectively. The number of transmissions complicated by motion artifact was also recorded.

RESULTS

One hundred patients had a fetal anatomy survey performed using the 256 kbps system, and these interpretations were compared with those from another group of 100 patients who were examined using the 384 kbps system. Although the visibility of the 33 anatomic items was similar using the two systems, significantly more examinations at 256 kbps were complicated by motion artifact (12% vs. 3%; P = 0.02).

CONCLUSIONS

Remote sonographic viewing of fetal anatomy was adequate using both 256 and 384 kbps systems, although motion artifact was significantly more likely to occur using the slower system. This problem may affect the ability of the lower-bandwidth system to allow optimal detection when fetal anomalies are present.

Cost issues surrounding the use of computerized telemedicine for obstetric ultrasonography

OBJECTIVE

The purpose of this study was to describe the cost implications of converting an established videotape review network for obstetric ultrasonography to one based on telemedicine technology.

DESIGN

Retrospective review of fixed and non-fixed costs associated with interpreting obstetric ultrasound examinations using both videotape and telemedicine transmission.

SUBJECTS

A network of three community offices transmitting 600 obstetric ultrasound examinations per month to a central tertiary level facility.

METHODS

Sonographers at the community offices record ultrasound examinations onto videotape, which are then sent by courier to a central facility for interpretation. At the completion of this videotaped examination, sonographers repeat the ultrasound scan while transmitting real-time images over a telemedicine link to the central facility. Costs associated with the videotape review technique that can be avoided by converting to telemedicine interpretation were derived and compared with the fixed and non-fixed costs associated with establishing the telemedicine network.

RESULTS

For this network, the fixed costs for establishing telemedicine are $101,750. Monthly non-fixed cost savings by eliminating videotape review include $1620 to $2700 for printing still images, $1200 for courier charges and $7000 for fewer repeat ultrasound examinations. Monthly non-fixed costs for the telemedicine network are $2415. Net monthly savings in non-fixed costs for a telemedicine network are therefore $7405 to $8585, which may pay for the initial fixed costs in 12 to 14 months.

CONCLUSIONS

The high cost of a telemedicine network may be offset by possible savings in non-fixed costs compared with alternative systems for interpreting obstetric ultrasonography.

Suggested ultrasound parameters for the assessment of fetal well-being during chronic hemodialysis

There are no published guidelines on how to assess fetal well-being during hemodialysis. We have developed a specific protocol of renal and obstetric interventions to ensure that hemodialysis is associated with minimal changes in fetal status. We tested this protocol serially over a 9-week period in a pregnant patient who was undergoing chronic hemodialysis for end-stage renal disease. Testing involved serial assessments of uterine and umbilical artery blood flow with Doppler velocimetry and continuous fetal heart rate tracings, before, during and after each hemodialysis session. We found that, by strict adherence to these guidelines, there were no significant alterations in maternal mean arterial blood pressure, continuous fetal heart rate tracings, uterine artery systolic/diastolic ratios, or umbilical artery systolic/diastolic ratios. We conclude that stable uteroplacental and fetal perfusion can be maintained during chronic hemodialysis in pregnancy by adhering to a specific set of precautions.

Paclitaxel in cisplatin or carboplatin-pretreated ovarian cancer. Phase II study

A phase II trial was conducted in order to assess the efficacy and toxicity of paclitaxel given at a dose of 175 mg/m2 in a 3-hour infusion every 3 weeks in patients with recurrent or cisplatin (CDDP) carboplatin-refractory ovarian cancer. Forty-two patients with a median age of 61 years (range 34-76 years) entered the study. Most patients had bulky disease. Thirty-three patients (78.5 %) presented with stage III and IV diseases. Twenty-two patients (52.3%) had previously been treated with only 1 regimen and 20 patients (47.7%) with > or = 2 regimens. The median treatment interval from the last previous therapy was 4.5 months (range 2-26 months). From 41 patients evaluable for response, 3 (7.3%) achieved a complete and 4 (9.8%) a partial response. All 3 complete and 2 out of the 4 partial responders had previously received > or = 2 chemotherapeutic regimens. Grade 3-4 toxicities included granulocytopenia (35%), which was of short duration, neurotoxicity (9.75%) and alopecia (60.9%). Two patients with grade 4 neutropenia were hospitalized due to pneumonia, which was successfully treated by broad-spectrum antibiotics and administration of G-CSF. A severe hypersensitivity reaction occurred in 1 patient early during the first cycle, resulting in discontinuation of treatment. Median relapse-free survival was 6.9 months, median time to progression 6.2 months and median survival 13.2 months. In conclusion, paclitaxel given at a dose of 175 mg/m2 as a 3-hour infusion every 3 weeks appears to be an efficacious and well-tolerated treatment in patients with recurrent or CDDP/carboplatin-refractory ovarian cancer.

Chemotherapy with methotrexate, carboplatin, mitoxantrone (Novantrone) and vincristine (Oncovin) in transitional-cell urothelial cancer

Forty-four patients with either metastatic or locally advanced transitional cell carcinoma of the bladder were treated with the MCNO regimen (methotrexate 300 mg/m2 in 1,000 ml normal saline as a 4-hour infusion on days 1 and 14 with leucovorin rescue 15 mg 6-hourly for 6 doses; carboplatin 300 mg/m2 in 250 ml 5% distilled water as a 1-hour infusion on day 1; mitoxantrone (Novantrone) 10 mg/m2 in 100 ml 5% distilled water as a 30-min infusion on day 1, and vincristine (Oncovin) 1 mg/m2 as an intravenous bolus on days 1 and 14. Patients with metastatic disease were treated with 6 cycles, while patients with locally advanced disease were treated with 4 cycles of induction chemotherapy followed by cystectomy or radiotherapy. The overall response rate was 40%, with 15% complete response (CR). The responses were better for patients with locally advanced disease (CR 25%, partial response, PR, 31.25%, response rate, RR, 56.25%) than for those with metastatic disease (CR 8.3%, PR 20.83%, RR 29.1 %). The differences in these results were probably due to the bad performance status and the presence of visceral metastases in patients with generalized disease. The overall median survival was 14 months, with responders living longer (median survival 28.8 months in patients with locally advanced disease and 22.9 months in patients with metastatic disease) than non-responders (median survival 16 months in patients with locally advanced disease and 8.9 months in patients with metastatic disease). The difference in survival between responders and non-responders was statistically significant in both groups of patients. Toxicity was moderate, but manageable. The MCNO regimen appears to have a lower efficacy than that obtained with cisplatin-based regimens for the treatment of metastatic disease and rather similar efficacy for the treatment of locally advanced urothelial-cell cancer. Therapy with this regimen, though less toxic, may not be a reliable alternative in elderly patients with visceral metastases and a performance status of > or = 2.

An outpatient phase II study of subcutaneous interleukin-2 and interferon-alpha-2b in combination with intravenous vinblastine in metastatic renal cell cancer

A prospective phase II trial was carried out to define the activity of a low-dose subcutaneous regimen of interleukin-2 (IL-2) and interferon alpha-2b (IFN-alpha) in combination with intravenous administration of vinblastine (VLB) in patients with metastatic renal cell cancer (RCC). Thirty-one patients with advanced RCC who had received no prior biochemotherapy were treated with IL-2 4.5 MU x 2/24 h thrice weekly for 2 weeks, IFN-alpha 3 MU/24 h thrice weekly (alternating days) for 2 consecutive weeks and VLB 4 mg/m2 every 3 weeks. Patients were to have a 1-week rest period after each 2 weeks of therapy with cytokines. Treatment was repeated every 3 weeks. Maximum duration of treatment was 1 year. Treatment was administered on an outpatient basis. There were 4 complete (12.9%) and 8 partial responses (25.8%), with an overall response rate of 38.7%. The median duration of response was 6.5 months. Responses were seen in lung, lymph nodes, bones, liver and other tumor metastases. Toxicity was mild to moderate, consisting of fever, anorexia, malaise and nausea-vomiting in > 80% of patients. Hypotension and transient alopecia occurred in > 20% of patients. Liver enzyme elevation was frequently observed. Treatment-induced eosinophilia occurred in the majority of patients, while in 52% of patients granulocytopenia grade II and grade III did not require dose modification of drugs. Transient inflammation and local induration at the injection sites was observed in the majority of patients. None of the patients experienced major VLB-related toxicity and no toxic deaths occurred. This three-drug combination immunochemotherapy may be a promising regimen with modest toxicity in advanced RCC.

Maternal morbidity associated with triplet pregnancy

The objective of this article is to describe maternal morbidity in a large cohort of triplet pregnancies managed by a single Maternal-Fetal Medicine group over a short period of time. Records from all triplet pregnancies managed and delivered from 1992 to 1996 were reviewed for maternal outcome data. Pregnancies delivered prior to 20 weeks were excluded. During the 4-year study period, 55 triplet pregnancies were managed and delivered at this center. The most common maternal complication was preterm labor, which occurred in 42 cases (76%). Preterm premature rupture of membranes occurred in 11 cases (20%). Pregnancy-induced hypertensive complications occurred in 15 cases (27%), which included severe preeclampsia 13 (24%), hemolysis, elevated liver function tests, and low platelets (HELLP) syndrome 5 (9%), and eclampsia 1 (2%). Other maternal antenatal complications included anemia 15 (27%), acute fatty liver of pregnancy 4 (7%), gestational diabetes 4 (7%), supraventricular tachyarrhythmias 2 (4%), dermatoses 2 (4%), urinary tract infection 2 (4%), and acute disc prolapse requiring surgery in 1 case (2%). Postnatal complications occurred in 18 cases (33%), including endometritis 13 (24%), postpartum hemorrhage 5 (9%), pneumonia 2 (4%), urinary tract infection 2 (4%), and diastasis of rectus muscles requiring surgery in 1 (2%). There were no maternal deaths. Antenatal and postnatal maternal complications occur in almost all triplet gestations, suggesting that such pregnancies be managed at centers that have appropriate multidisciplinary expertise available.

Superiority of carboplatin monochemotherapy over carboplatin-based polychemotherapy in ovarian cancer

Forty patients with previously untreated epithelial ovarian cancer (OC), with FIGO stages Ic-IV, were randomly allocated to receive intravenously either carboplatin (C) 400 mg/m2 every three weeks (C arm, 20 patients) or a combination of C 350 mg/m2, ifosfamide (I) 5 g/m2 with mesna every three weeks, vincristine (V) 1.4 mg/m2 (maximum total dose 2 mg) and bleomycin (B) 30 mg every ten days (CIVB arm, 20 patients). Responding patients received 6 courses of chemotherapy and all 40 patients were evaluable for toxicity, response and survival. Clinical characteristics of patients were similar in both arms. Clinico-imaging results with chemotherapy were as follows: in C arm, clinical complete remission (cCR) 11 (55%) and partial remission (cPR) five (25%) patients for an overall response rate (ORR) 80%. For CIVB arm, cCR ten (50%) and cPR four (20%) patients for an ORR 70%. Second look operation (SLO) was performed in three of the 11 cCR patients in the C arm and six of the ten cCR patients in the CIVB arm. Pathological CR (pCR) was confirmed in two of the three cCR C arm patients and two of the six in the CIVB patients. In the first interim analysis statistically significant differences, all favoring monochemotherapy, were seen in response duration, time to progression, disease-free and overall survival. These results along with the severe myelotoxicity resulting in dose reductions in the CIVB patients led us to stop enrolling new patients and follow this population closely for long-term results. These confirmed the first observations of the superiority of single-agent carboplatin in response duration (p = 0.034), time to progression (p = 0.028), disease-free survival (p = 0.010) and overall survival (p = 0.043). Because of the above reasons we have concluded that monochemotherapy with carboplatin is to be preferred over carboplatin in combination with other drugs.

Poor perinatal outcome associated with maternal Brucella abortus infection

BACKGROUND

Reports suggest that perinatal infection with Brucella abortus does not cause poor obstetric outcomes, because of protective mechanisms in the human, not seen in animal species.

CASE

We report a case of maternal brucellosis resulting in preterm labor, chorioamnionitis, placental abruption, and delivery of a live-born infant at 25 weeks' gestational age. Both maternal blood cultures and amniotic fluid cultures were positive for B abortus species, and delivery occurred despite aggressive antibiotic and tocolytic therapy.

CONCLUSION

Maternal infection with B abortus during pregnancy can lead to significant perinatal morbidity, casting doubt on reports that human pregnancy is resistant to such infection.

Gender differences in twin-twin transfusion syndrome

OBJECTIVE

To determine whether there is a gender discrepancy in severe twin-twin transfusion syndrome.

METHODS

All cases of twin-twin transfusion syndrome evaluated between 1989 and 1996 were reviewed retrospectively. The following sonographic criteria were used: a single placenta, a thin membrane, the same gender, a combination of polyhydramnios-oligohydramnios, a stuck twin, and an estimated weight discordance exceeding 20%. At least five of six sonographic criteria were required for inclusion in the study. Only severe cases, which were defined as early onset (before 30 weeks' gestation), a combination of polyhydramnios and oligohydramnios, a stuck twin, fetal hydrops, fetal death, or the requirement of medical or invasive treatment, were included. Chorionicity was confirmed by placental examination when available.

RESULTS

Thirty-seven twin pregnancies met the above criteria, of which 33 (89%) twin pairs were female. The median gestational age at presentation was 19 weeks (range, 15-29; standard deviation, 5.6). A single placenta, thin membrane, same gender, and polyhydramnios-oligohydramnios were present in every case. A stuck twin was noted in 34 of 37 cases (92%), and a growth discordance exceeding 20% was present in 26 of 36 (72%). Placental pathology, which was available in 31 (84%) cases, confirmed a monochorionic placentation in 29. Twenty-five (68%) cases had reduction amniocentesis, two were treated with indomethacin, one underwent a cord ligation, and in four cases, fetal death occurred before treatment was instituted.

CONCLUSION

There is a significant female preponderance in pregnancies complicated by severe twin-twin transfusion syndrome. The reasons for this are nuclear, but they may be related to either placental or fetal gender-specific differences affecting a subset of monochorionic twin pregnancies.

Validation of first-trimester telemedicine as an obstetric imaging technology: a feasibility study

OBJECTIVE

To establish whether first-trimester obstetric ultrasonography interpreted by a live video telemedicine link is comparable to an established videotape review network in a low-risk patient population.

METHODS

An integrated services digital network was established from three satellite offices to our central prenatal diagnostic center. All patients had a sonographic evaluation of the uterus, adnexa, and gestational sac recorded onto videotape by a trained sonographer. A live, interactive video telemedicine link was established, and a perinatologist directed the sonographer through the scan. Subsequently, a different perinatologist, blinded to the telemedicine interpretation, reviewed the original videotaped examination. The reports generated from both modalities then were compared by means of a score of 12 sonographic characteristics.

RESULTS

The first 100 patients were included. The mean gestational age (+/-standard deviation) was 8.9 +/- 2.3 weeks (range 5.7-14.4), and the mean duration for telemedicine scans was 7.8 +/- 2.9 minutes (range 3.8-20.1). Telemedicine and videotape review scores were the same in 95 cases, and the final diagnosis was identical in 98 cases. This study had 80% power to detect a 10% difference in diagnosis at a significance level of .05. The ability to detect abnormalities was equivalent using both systems.

CONCLUSION

The interpretation of first-trimester obstetric ultrasonography using live video telemedicine is equivalent to a system of videotape review. Obstetric telemedicine may prove to be a useful tool for providing sonographic imaging for low-risk obstetric patients.

Validation of fetal telemedicine as a new obstetric imaging technique

OBJECTIVE

Our purpose was to establish whether obstetric ultrasonography interpreted by a live video telemedicine link is comparable to interpretation by videotape review in a low-risk patient population.

STUDY DESIGN

An Integrated Services Digital Network (ISDN 6) was established from three satellite offices to our central prenatal diagnostic center. Patients seen at these satellite offices had a complete fetal anatomic survey recorded onto videotape by a trained ultrasonographer. A live interactive video telemedicine link was then established to our center by the digital network, and a perinatologist directed the ultrasonographer through the anatomy survey. Subsequently a different perinatologist, blinded to the telemedicine interpretation, reviewed the videotaped examination. The reports from the videotaped and telemedicine scans were then compared on the basis of a score of 33 anatomic items.

RESULTS

The first 200 patients seen at the satellite offices were included. Telemedicine and videotape interpretations provided similar scores in 84% of scans. In 17 of the 33 anatomic categories telemedicine provided significantly better scores than videotape, whereas in the remaining 16 anatomic categories the scores were equivalent. More videotape than telemedicine examinations required repeat ultrasonography because of suboptimal imaging (10% vs 3%, p = 0.003).

CONCLUSIONS

The interpretation of obstetric ultrasonography with use of live video telemedicine is comparable to videotape review. Fetal telemedicine may prove to be a useful tool for providing ultrasonographic interpretation of fetal anatomy to a network of low-risk obstetric practices.

Pitfalls of the 'double bubble' sign: a case of congenital duodenal duplication

The 'double bubble' sign in prenatal diagnosis is most often associated with duodenal atresia. However, other causes of upper intestinal obstruction and cystic abdominal masses need to be considered. One possible diagnosis that can mimic the 'double bubble' sign of duodenal atresia is duodenal duplication, but little information is available to guide sonologists in the prenatal diagnosis of this rare congenital anomaly. In this case report we describe the successful prenatal diagnosis of duodenal duplication, by relying on the early gestational age of presentation, the lack of polyhydramnios, the failure to consistently demonstrate a 'double bubble' on transverse images, and the presence of a normal distal bowel pattern.

CEA, CA 19-9, and CA-50 in monitoring gastric carcinoma

This study was conducted to investigate the clinical utility of CEA, CA 19-9, and CA-50 in the diagnosis, monitoring, and prognosis of 62 gastric carcinoma patients having either adjuvant or palliative chemotherapy. Patients were divided in two groups: group A included patients treated on an adjuvant basis following a curative resection of gastric cancer, and group B included patients with residual disease post surgery or patients with inoperable tumor or generalized disease. Serum marker levels were measured in a prospective study just before the initiation of chemotherapy and before each course during chemotherapy. In group A, CEA was positive in 2/25 (8%) patients, CA 19-9 in 1/25 (4%), and CA-50 in 1/25 (4%). In group B the sensitivity of CEA was 48.6% (18/37 patients), of CA 19-9 64.9% (27/37 patients), and of CA-50 70.3% (26/37) patients. There was a significant correlation between the CA 19-9 and CA-50 levels in both groups. No correlation was found between the sensitivity or the absolute initial marker levels and the tumor's differentiation or extent of disease. In group A the only patient with initially elevated CA 19-9 and CA-50 values relapsed early while he was on adjuvant chemotherapy. It was also found that the rising final CA 19-9 and CA-50 values at the end of chemotherapy were correlated with an increased incidence of relapse, but not with the disease-free interval. In group B the initially low marker levels showed a trend to predict a favorable outcome of treatment. There was no statistically significant correlation between the marker titers before each course and response to chemotherapy. It is concluded that the comeasurement of CA 19-9 and CA-50, and to some degree of CEA, is justifiable for gastric cancer. The estimation of CA 19-9 and CA-50 may be useful for early detection of recurrence after curative surgery and adjuvant chemotherapy. In advanced or recurrent gastric cancer, the estimation of either CA 19-9 or CA-50 and CEA serum values may help in checking the prognosis, determining the efficacy of palliative treatment modalities, and recognizing recurrences.

Comparison of two different doses of ondansetron plus dexamethasone in the prophylaxis of cisplatin-induced emesis

This study was conducted to evaluate the efficacy of two different doses of ondansetron (8 mg vs. 24 mg) plus dexamethasone in the prevention of cisplatin (CDDP)-induced emesis and nausea (acute and delayed). The persistence of the anti-emetic efficacy during the second cycle of chemotherapy was also assessed. Eighty patients receiving high-dose CDDP (>80 mg/m2) were randomized to have either ondansetron 8 mg plus dexamethasone 20 mg (8 mg group) or ondansetron 24 mg plus dexamethasone 20 mg (24 mg group), given intravenously as a single dose before the CDDP infusion. From days 2-5, all patients received oral ondansetron 8 mg twice daily. Seventy-five patients (38 in the 8 mg group and 37 in the 24 mg group) were evaluable for analysis. Among these, there were 24 patients who received ifosfamide (IFO) on the 2nd day of treatment; these patients were evaluated separately for delayed emesis. Complete protection from acute emesis was obtained in 26 (68.4%) and 26 (70.3%) patients, in the two groups, respectively. Complete protection against acute nausea was achieved in 23 (60.5%) and 24 (64.9%) patients, respectively. With respect to the delayed emesis, complete protection was achieved in 14 (56%) and 13 (50%) patients not receiving IFO and in 4 (30.8%) and 3 (27.3%) of those receiving IFO. The figures for the delayed nausea were: 12 (48%) and 13 (50%), 2 (15.4%) and 2 (18.2%), respectively. Similar protection against emesis and nausea was recorded during the second cycle of chemotherapy. Both regimens have the same efficacy and thus, taking into account the cost-effectiveness, 8 mg of ondansetron plus dexamethasone in a single intravenous dose should be used for the prevention of high-dose CDDP-induced emesis.